02 Leveraging paramedic data to investigate the effect of COVID-19 on community opioid overdoses

2021 ◽  
Vol 38 (9) ◽  
pp. A1.2-A2
Author(s):  
J Chris Smith ◽  
Wesley Burr
Keyword(s):  
Harm Reduction ◽  
Goodness Of Fit ◽  
P Value ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Data Ethics ◽  
Community Monitoring ◽  
Chi Squared ◽  
Containment Measures ◽  
Bystander Naloxone

BackgroundOpioid overdoses in Canada have shown dramatic increases over recent years, despite significant investments in harm reduction. Most community monitoring currently relies on emergency department and coroner data. Our team has previously shown that paramedic data can be a useful addition to the current metrics as paramedics regularly interact with opioid overdose patients. This study examines paramedic data to investigate the changes to community opioid overdoses in the era of COVID-19 to better support our strategic partners in their battle against the opioid crisis.MethodsThe electronic ambulance call report database of Peterborough Paramedics (Ontario, Canada) was examined. De-identified records for patients from 2017-2020 with documented problem codes of ‘Opioid Overdose’ were extracted. Patients receiving paramedic naloxone were also included. The data was cleaned and analysed, and incomplete records were removed. Statistical models including chi-squared tests of goodness-of-fit and post hoc pairwise t-tests were applied to the data. Ethics approval for this study was granted by the Trent University’s Research Ethics Board.Results788 opioid overdoses were identified out of 72,737 patients. There were 263 opioid overdoses found in 2020 representing 1.4% patients, a significant increase from 2017-2019 (p value: 0.006). The proportion of patients receiving paramedic naloxone was significantly increased from previous years (p value: 0.005) while bystander naloxone administration was significantly decreased (p value 0.002). Age, gender, and pick-up location types were not significantly different between 2020 and previous years.ConclusionDespite reduced overall call volumes in 2020, paramedics observed an increase in opioid overdoses. The increase in paramedic naloxone administration and decrease in bystander naloxone administration may indicate changes in usage practices of community opioid users or an instability in the drug supply. These factors must be considered in future opioid harm reduction strategies and public health COVID-19 containment measures.

scholarly journals Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0259126
Author(s):  
Amina Moustaqim-Barrette ◽  
Kristi Papamihali ◽  
Sierra Williams ◽  
Max Ferguson ◽  
Jessica Moe ◽  
...  
Keyword(s):  
British Columbia ◽  
Adverse Events ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Real World Data ◽  
Naloxone Administration ◽  
Severe Withdrawal ◽  
Policy Program ◽  
Bystander Naloxone ◽  
Overdose Deaths

Introduction Take-Home Naloxone programs have been introduced across North America in response to rising opioid overdose deaths. There is currently limited real-world data on bystander naloxone administration, overdose outcomes, and evidence related to adverse events following bystander naloxone administration. Methods The research team used descriptive statistics from Take-Home Naloxone administration forms. We explored reported demographic variables and adverse events among people who received by-stander administered naloxone in a suspected opioid overdose event between August 31, 2012 and December 31, 2018 in British Columbia. We examined and contextualized differences across years given policy, program and drug toxicity changes. We used multivariate logistic regression to examine whether an association exists between number of ampoules of naloxone administered and the odds that the recipient will experience withdrawal symptoms. Results A large majority (98.1%) of individuals who were administered naloxone survived their overdose and 69.2% had no or only mild withdrawal symptoms. Receiving three (Adjusted Odds Ratio (AOR) 1.64 (95% Confidence Interval (CI): 1.08–2.48)) or four or more (AOR 2.19 (95% CI: 1.32–3.62)) ampoules of naloxone was significantly associated with odds of moderate or severe withdrawal compared to receiving one ampoule of naloxone. Conclusions This study provides evidence from thousands of bystander reversed opioid overdoses using Take-Home Naloxone kits in British Columbia, and suggests bystander-administered naloxone is safe and effective for opioid overdose reversal. Data suggests an emphasis on titration during bystander naloxone training in situations where the person experiencing overdose can be adequately ventilated may help avoid severe withdrawal symptoms. We identified a decreasing trend in the likelihood of moderate or severe withdrawal over the study period.

scholarly journals Dark energy survey internal consistency tests of the joint cosmological probes analysis with posterior predictive distributions

2021 ◽  
Vol 503 (2) ◽  
pp. 2688-2705
Author(s):  
C Doux ◽  
E Baxter ◽  
P Lemos ◽  
C Chang ◽  
A Alarcon ◽  
...  
Keyword(s):  
Dark Energy ◽  
Internal Consistency ◽  
Goodness Of Fit ◽  
Small Scale ◽  
P Value ◽  
Posterior Predictive Distribution ◽  
Data Set ◽  
Dark Energy Survey ◽  
Data Vector ◽  
Energy Survey

ABSTRACT Beyond ΛCDM, physics or systematic errors may cause subsets of a cosmological data set to appear inconsistent when analysed assuming ΛCDM. We present an application of internal consistency tests to measurements from the Dark Energy Survey Year 1 (DES Y1) joint probes analysis. Our analysis relies on computing the posterior predictive distribution (PPD) for these data under the assumption of ΛCDM. We find that the DES Y1 data have an acceptable goodness of fit to ΛCDM, with a probability of finding a worse fit by random chance of p = 0.046. Using numerical PPD tests, supplemented by graphical checks, we show that most of the data vector appears completely consistent with expectations, although we observe a small tension between large- and small-scale measurements. A small part (roughly 1.5 per cent) of the data vector shows an unusually large departure from expectations; excluding this part of the data has negligible impact on cosmological constraints, but does significantly improve the p-value to 0.10. The methodology developed here will be applied to test the consistency of DES Year 3 joint probes data sets.

Intranasal naloxone administration by police first responders is associated with decreased opioid overdose deaths

2015 ◽  
Vol 33 (9) ◽  
pp. 1201-1204 ◽  
Author(s):  
Jessica Rando ◽  
Derek Broering ◽  
James E. Olson ◽  
Catherine Marco ◽  
Stephen B. Evans
Keyword(s):  
First Responders ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Overdose Deaths

Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14050-e14050
Author(s):  
Olusola Michael Adeleke ◽  
Rubyyat A Hakim ◽  
Laurence Dean ◽  
Huma Zahid ◽  
Rongyu Lin ◽  
...  
Keyword(s):  
Goodness Of Fit ◽  
Single Point ◽  
District General Hospital ◽  
Cord Compression ◽  
Radiology Reporting ◽  
Goodness Of Fit Test ◽  
Tertiary Centre ◽  
Chi Squared ◽  
Early Case ◽  
The Uk

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

Abstract P381: Pre-Treatment Perfusion Mismatch Volumes in Ischemic Stroke Patients Treated With Tenecteplase or Alteplase

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adrienne N Dula ◽  
Ian M Alrahwan ◽  
Steven J Warach
Keyword(s):  
Imaging Modality ◽  
Infarct Volume ◽  
Volume Growth ◽  
Logistic Models ◽  
P Value ◽  
Full Cohort ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Chi Squared ◽  
Pre Treatment

Introduction: The overall goal of this study is to evaluate the relationship of pretreatment perfusion mismatch volumes to outcomes in patients receiving alteplase (ALT) to those receiving tenecteplase (TNK). Methods: This study included patients receiving treatment with ALT (0.9 mg/kg; max, 90 mg) or TNK (0.25 mg/kg; max, 25 mg) between 09/01/2017 - 06/30/2020 identified through our local stroke registry stroke registry. Of the 505 patients meeting these criteria, 280 have been screened, including patients receiving EVT (n=94) and a sampling of n=111 from the ALT group and 75 from the TNK group. Final eligibility will be patients with a pretreatment perfusion deficit, mismatch > 15 mL, and mismatch (MM) ratio ≥ 1.2. Volumes are based on RAPID software (iSchemiaView). Using univariate (chi-squared with continuity correction or Mann-Whitney U) and adjusted logistic models, the effect of lysis type and pre-treatment imaging were assessed on the primary outcome of discharge disposition. Results: A total of 93 patients were included in our analysis, 40 receiving ALT and 53 patients receiving TNK, demographics found in Table 1. Discharge to home occurred in 48.8% (20/40) of patients treated with ALT and 30.7% (16/53) treated with TNK, odds ratio (OR), 0.47; 95% CI [0.20, 1.09], (P-value for OR=0.0766). Upon adjustment for EVT, age, sex, NIHSS on admission, imaging modality, cohort imbalances (marked by *), and MM, the relation of lysis type to discharge to home gave an OR of 0.25; 95% CI [0.06, 0.90], P= 0.0383) with age (P<0.0001) and imaging modality (P=0.0020) significantly contributing to the model. Lysis type did not significantly influence discharge to hospice or death (OR, 0.62; 95% CI [0.05, 6.86], P=0.6945) upon adjustment for baseline factors. Conclusion: In this preliminary analysis, MM volumes did not contribute to the outcome of discharged to home. Analysis of the full cohort is ongoing and final analyses will relate lytic type to infarct volume growth and clinical outcomes.

Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

2021 ◽  
Vol 17 (2) ◽  
pp. 109-113
Author(s):  
Julienne K. Kirk, PharmD, CDE, BCPS ◽  
Matthew Q. Tran, PharmD ◽  
Samantha Pelc, PharmD ◽  
Katherine G. Moore, PharmD, BCPS, BCACP
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Family Medicine ◽  
Quality Improvement Intervention ◽  
Opioid Overdose ◽  
Naloxone Administration ◽  
Support Person ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

Edinburgh Handedness Inventory Scores: Caucasian and American Indian College Students

1994 ◽  
Vol 78 (2) ◽  
pp. 675-680 ◽  
Author(s):  
Sherry M. Dingman ◽  
Mary A. Mroczka
Keyword(s):  
College Students ◽  
American Indian ◽  
American Indians ◽  
Goodness Of Fit ◽  
Single Gene ◽  
Empirical Support ◽  
Racial Groups ◽  
Frequency Distributions ◽  
Chi Squared ◽  
American Indian College Students

Laterality Quotients for 80 American Indian college students were less right-biased than those for 80 Caucasian college students on the Edinburgh Handedness Inventory. Oldfield's 1971 empirically derived deciles for the Edinburgh Handedness Inventory were used to assign decile levels to the data. Deciles were then used to assign data to one of three proposed handedness phenotype classifications. Pheno-type classifications were based on Annett's 1985 proposed distribution for a single gene theorized to underlie human handedness. Chi-squared goodness-of-fit analysis showed that the data for Caucasian college students did not differ significantly from what would be anticipated by Annett's model, but American Indians differed significantly. Results provide empirical support for the hypothesis that frequency distributions for Annett's hypothesized right-shift gene may differ across racial groups.

scholarly journals Correlates of Knowledge of HIV Transmission Among Incident Cases of HIV in a Cohort of Injection Drug Users Receiving Harm Reduction Services at Karachi, Pakistan

2014 ◽  
Vol 16 (3) ◽  
pp. 286-289 ◽  
Author(s):  
Rab Nawaz Samo ◽  
Arshad Altaf ◽  
Sharaf Ali Shah
Keyword(s):  
Harm Reduction ◽  
Injection Drug Users ◽  
Drug Users ◽  
Hiv Transmission ◽  
Critical Role ◽  
Unprotected Sex ◽  
Injection Drug ◽  
P Value ◽  
High Risk Population ◽  
Incident Cases

Background: Knowledge of risk factors for HIV transmission in high-risk population plays a critical role in averting the risk of HIV transmission. In Pakistan, injection drug users (IDUs) constitute the core risk group of HIV prevalence, where the epidemic has transitioned to a “concentrated level.” Still nothing is known about the role of knowledge in HIV transmission and HIV sero-conversion among IDUs in Pakistan. Methods: From 2009 to 2011, a nested case–control study was conducted in a cohort of 636 IDUs receiving harm reduction services in the mega city of Karachi. Results: In multivariable regression analysis, 3 factors, namely HIV does not spread through unprotected sex (adjusted odds ratio [AOR]: 3.1, 95% confidence interval [CI] 1.39-6.90, P value .01), HIV does not transmit by sharing syringes (AOR: 3.5, 95% CI 1.97-6.40, P value <.00), and the risk of HIV cannot be minimized by using new syringe every time (AOR: 2.0, 95% CI 1.16-3.60, P value .01), were significantly associated with the incident cases of HIV. Conclusion: The study findings suggest the association between knowledge of HIV transmission and HIV sero-incident cases.

DISTRIBUTIONAL ANALYSIS OF RELATED SYNSETS IN WordNet FOR A WORD SENSE DISAMBIGUATION TASK

2005 ◽  
Vol 14 (06) ◽  
pp. 919-934 ◽  
Author(s):  
KOSTAS FRAGOS ◽  
YANIS MAISTROS
Keyword(s):  
Target Word ◽  
Goodness Of Fit ◽  
Hypothesis Test ◽  
Word Sense Disambiguation ◽  
The Other ◽  
Reasonable Assumption ◽  
P Value ◽  
Word Sense ◽  
Chi Square ◽  
Sense Disambiguation

This work presents a new method for an unsupervised word sense disambiguation task using WordNet semantic relations. In this method we expand the context of a word being disambiguated with related synsets from the available WordNet relations and study within this set the distribution of the related synset that correspond to each sense of the target word. A single sample Pearson-Chi-Square goodness-of-fit hypothesis test is used to determine whether the null hypothesis of a composite normality PDF is a reasonable assumption for a set of related synsets corresponding to a sense. The calculated p-value from this test is a critical value for deciding the correct sense. The target word is assigned the sense, the related synsets of which are distributed more "abnormally" relative to the other sets of the other senses. Our algorithm is evaluated on English lexical sample data from the Senseval-2 word sense disambiguation competition. Three WordNet relations, antonymy, hyponymy and hypernymy give a distributional set of related synsets for the context that was proved quite a good word sense discriminator, achieving comparable results with the system obtained the better results among the other competing participants.

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